A recent national survey of 1,000 adults currently using GLP-1 receptor agonist (GLP-1 RA) medications has revealed significant concerns about potential side effects, with more than one-third of respondents worried about the loss of lean muscle mass. Conducted in May by the biopharmaceutical company Veru, the survey indicates that over half of the participants are making lifestyle changes to mitigate these adverse outcomes. The survey underscores the critical role of primary care clinicians in advising patients on the benefits and risks associated with GLP-1 RA therapy before initiation.
Among the most pressing concerns, 36% of respondents rated their perceived risk of muscle loss or weakness as moderate to very high. This concern was second only to gastrointestinal side effects, which 50% of respondents rated as moderate to very high, and neurologic symptoms such as fatigue or dizziness, reported by 44%.
Understanding the Risks and Responses
While only 15% of respondents reported experiencing muscle loss, this figure rose to 32% among those aged 60 and older—more than double the overall rate. The survey highlights that early-stage muscle mass decline can persist for months or years before becoming noticeable, particularly in younger, stronger individuals.
Many participants have adopted new behaviors aimed at preserving muscle mass. Regarding diet, 36% reported following a high-protein diet, and 55% are consuming more whole foods, such as fruits, vegetables, and lean proteins. In terms of physical activity, 63% engage in regular cardio exercises, and 38% perform strength or resistance training—both known to help prevent lean mass loss. Additionally, 33% practice low-impact or flexibility-based exercises like yoga or stretching, while only 14% reported no meaningful physical activity.
The Role of Primary Care Clinicians
Before beginning GLP-1 RA therapy, respondents sought information from various sources. The majority (61%) consulted their general physician or primary care clinician, significantly outpacing other sources like friends and family (30%), pharmacists (25%), and online health portals such as Mayo Clinic or WebMD (24%). Only 6% turned to government agencies like the CDC or NIH, while 13% used generative AI tools such as ChatGPT or Claude.
Mitchell Steiner, MD, CEO of Veru, emphasized the importance of addressing these concerns, particularly among the senior population.
“It is evident that patients are aware of the substantial risk that GLP-1 RAs pose to their muscle mass and physical function,” Steiner stated. “While diet and exercise are instrumental in combating lean mass decline, there is a mounting need—especially among the senior population—for treatments that can address the muscle loss which accompanies GLP-1 RAs. It is imperative that patients are presented with all the measures at their disposal to protect their long-term wellbeing.”
Potential Solutions and Future Directions
The survey findings also point to the potential for pharmacologic adjuncts to GLP-1 RA therapy. Veru is currently developing enobosarm, an investigational selective androgen receptor modulator. A phase 2b study reported that participants taking enobosarm along with semaglutide (Wegovy; Novo Nordisk) experienced a significantly smaller decline in lean mass (1.2% vs. 4.1% with semaglutide alone) and greater total fat loss (10.9% vs. 8.6%). A follow-up maintenance study showed that enobosarm “completely prevented fat regain and preserved lean mass in both enobosarm dose groups compared to placebo” 12 weeks after Wegovy discontinuation. Veru has scheduled a meeting with the FDA to plan a Phase 3 trial.
As the use of GLP-1 medications expands in obesity and cardiometabolic care, these findings suggest that informed, ongoing dialogue between clinicians and patients will be essential—not only to manage expectations and side effects but to preserve long-term physical function.
The announcement comes as GLP-1 medications continue to transform obesity medicine, underscoring the need for integrating nutrition and lifestyle support for sustainable weight loss and health benefits. As the conversation around GLP-1 therapy evolves, the importance of comprehensive patient education and the exploration of adjunct therapies remain at the forefront of improving patient outcomes.
